Being admitted at a mental health hospital can be an overwhelming and intense experience. It can bring a tough mixture of fear and confusion depending on the circumstances of admission.
The initial moments can be disorientating and unsettling where some personal freedoms are restricted
Relinquishing some possessions and overall control can add to the feeling of vulnerability. All too often unfortunately, the built environment is making this difficult situation worse.
The hospital setting can feel sterile, confusing, even intimidating. Well-meaning and necessary safety measures such as anti-ligature fixtures and fittings can seem alien when experienced for the first time. Indeed, some experts by experience report experiencing new trauma from their in-patient experience. Buildings shouldn’t do this.
This is where good architecture and good design can help ensure those vital first moments and experiences are warm, friendly and reassuring. It ensures that the built environment matches the excellent quality of the care environment provided by staff.
At Gilling Dod, we have produced several different approaches to this in our recent mental healthcare design. Each one integrates nature in different ways.
At Mossley Hill Hospital, an 80-bed adult acute unit currently under construction for Mersey Care NHS Foundation Trust, the main entrance provides a view through the reception area towards a cluster of specimen mature birch trees in a winter garden beyond. This transparent entrance into the building provides an open and honest approach to admission. The view to matures trees gives a reassurance that someone isn’t going into some unknown, closed-off asylum. Once inside, curved walls are used at key junctions to provide a smooth flow of movement.
The use of natural courtyards continues at wards entrances. Instead of open straight into a busy communal ward area, a large lobby looks out onto nature before gradually opening into the ward. This takes learning from specialist pathways where a transition zone such as this are a simple but important measure to regulate emotion going from one department to another.
Promotion of nature is also utilised at North View in Manchester. The large 150-bed hospital comprising of adult acute, older adult and psychiatric intensive care wards. Here, the calming measures take place even further back from the entrance threshold. Landscape architects Iteriad have creating a beautiful meandering path weaving gently up to the front door. As the ground slopes up, curved seating under mature pine trees feature at each corner of the path. A sinuous blue ribbon wall guide people up towards the entrance. By not following the direct straight line, you are forced not to rush and you become more mindful. The impact is dramatic. You arrive at reception feeling refreshed and cared for through the thought and attention to detail that have been given by the landscape’s designers.
Once at reception, an enticing view of a café garden then leads you inside. The building massing has been crafted to ensure natural light illuminates that garden view acting as a beacon to entice you through the secure line.
Ward entrances are denoted by feature timber landmarks. The flow of movement onto ward is spacious and carefully curated to avoid tight, abrupt spaces that are prevalent on many units.
Even simple, cost neutral design choices can have a major impact. At Red Kite View, the multi-award-winning children and young people’s mental health unit in Leeds has been designed around an impressive existing grand weeping willow tree. The nurturing branches of the tree guides your route towards the front entrance. The unit’s school at First Floor overlooks the canopy of the tree. Utilising existing site features are a powerful tool to integrate a building into its surroundings.
Each of these three examples were created as part of patient co-production process where the patient journey was carefully designed and mapped.
The right first impression has big impact for staff and family members. For family visiting, it is reassuring to visit a well planned, coherent environment. For staff, a well designed environment enriches. It reduces stressors and aids with recruitment and retention.
The common themes that unite each of these examples of making the right first impression are: quality of daylight, clear and simple movement flow, and intuitive wayfinding; all bound together with a tight integration of nature.
Curated window openings designed to maximise the benefits of natural light and bring an uplifting feel to any space.
Ensuring a smooth flow of movement enables a reduction in apprehension and uncertainty
This can be achieved by targeted chamfered of corners at key junctions and decision points.
The two measures above form the essential ingredients for intuitive wayfinding that good signage will only need to supplement, not lead.
The last piece is nature. Following biophilic principles, and weaving nature and especially impactful mature trees into any healthcare environment isn’t without challenges, not least for safety and maintenance reasons, but introduced in the right way, the benefits can be amazing. Not only does it provide serenity and grounding for a building’s users, it also addresses biodiversity requirements in a cost effective manner. The example at Mossley Hill places big trees safely within a central courtyard visible from the entrance and the café and serves to draw people in and anchor the heart of the building.
The precious opportunities to interact with nature can be limited in a mental health setting. Ligature risks posted by trees and concealment opportunities from dense shrubs are hazards to be cautious about. Plus an ever-increasing acuity level across in-patient mental health services means the approach to risk is evolving. This is why managing and curating access to nature is so important.
If a risk is perceived too high, it is vital to not simply omit these measures but to reimagine how they are implemented
Getting the entrance right sets the scene for the whole patient experience. Ensuring someone feels cared for by the physical setting is the best thing any designer can do.
